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10100168 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10400 IMPERIAL AVE CONTRACTOR:M&S ROOFING CO. PERMIT NO: 10100168 OWNER'S NAME: SHERRY CHEN 208 COPCO LN DATE ISSUED: 10/22/2010 VER'S PHONE: 4084469005 SAI 1 JOSE,CA 95123 PHONE NO:(408)314-0870 ❑ LICENSED CONTRACTOR'S DECLARATION i BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB� License Class Lic.#� ©� � 1 � MECN I- RESIDENTIAL r- COMMERCIAL Contractor L Date 10 I hereby affirm that I am lic nsed under the provisions of Chapter 9 JO 3 DESCRIPTION: RE-ROOF REMOVE SHAKE ROOF&INSTALL OSB& (commencing with Section 7000)of Division 3 of the Business&Professions PRE SIDENTIAL TL CLASS A 33SQ Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$16000 Section 3700 of the Labor Code,for the performance of the work for w ich this APPLICANT CERTIFICATION permit is issued. (�� , i API1 Number:35719094.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Isst ed by:, Date:�G�-Z 2�; Signature � Date — f V OWNER-BUILDER DECLARATION RE-ROOFS: All i oofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of inti lied without first obtaining an inspection,I agree to remove all new materials for the following two reasons: insp xtion. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structurC is not intended or offered for sale(Sec.7044, Sigr ature of Applicant: Date) 0 Business&Professions Code) _ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I ha✓e read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. cont aminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Hea th&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owl o authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Dater forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I herby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address nnify and keep harmless the City of Cupertino against liabilities,judgments, .,and expenses which may accrue against said City in of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I unc erstand my plans shall be used as public records. 9.18. Lice ised Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT F_ECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 3571S094 . 00 DATE ISSUED. . . . . . . : 10/22 /2010 RECEIPT #. . . . . . . . . : BS000011823 REFERENCE ID # . . . : 1O1OC168 SITE ADDRESS . . . . . : 1040C IMPERIAL AVE SUBDIVISION . . . . . . CITY CUPEF TINO IMPACT AREA . . . . . . OWNER SHERFY CHEN ADDRESS . . . . . . . . . . : 1040C IMPERIAL AVE CITY/STATE/ZIP . . . : CUPEFTINO, CA 95014-5047 RECEIVED FROM . . . . : M & S ROOFING CO CONTRACTOR . . . . . . . : MIRSPD KRAJWIC LIC # 28360 COMPANY . . . . . . . . . . : M & S ROOFING CO. ADDRESS 208 COPCO LN CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 314-0870 FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 16, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 16, 000 . 00 1 . 60 0 .00 1. 60 0 .00 1REROOFRES SQ FEET 33 . 00 429 . 00 0. 00 429. 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 431 . 60 0 . 00 431 .60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 431 . 60 #2512 --------------- TOTAL RECEIPT 431 .60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$1,600 *PERMIT TYPE: Minor Building Permit PLAN C HECK TYPE: Re-roof PRIMARY r', PENTAMATION USE: SFD or Duplex ;Jr 1 SFDWLROOF t 1`�_` 1 PERMIT TYPE: WORK SCOPE FEE ID ROOF AR EA s.f. 1 REROOFFRES 3,300 I('t'_ t�1.Itt�.�i2c'C�{ Fird), f�£i P-'tI��c'L--.', I'iCC. '�'." 01h, I'h rr' IranLj Ofitc-11<<z't. 1»sf. NOTE. Thesefees are based on the preliminary information avaA,able and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resohition 09-051 Et� 717/10) FEE QTY/FEE MISC ITEMS Ph�lrlla. .t�f� l tc� �'tt,ll ChCcl,. Permit Fee: $429.00 �t.ih'1�c 1'krlrtzi7 I�t��: J'ax "�CU1dSlti'l.1� hc'1'7Cti 1'£'t: Work Without Permit? 0 Yes 0 No $0.00 Trcr;e1 1 o"tri-li-niatim, FCCS: I Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $430.50 $0.00 TOTAL FEE- $430.501 Revised: 10/17/2010 INPUT Resources • 1ATHeafth M.Undoor Air Quality and Finishes 1.Use LowMo-VOC Paint 1 IA(/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes 0 3.Use LowMo VOC Adhesives 3 IAO/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Re source pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AO/Health pts y=yes D 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAI/Health pts y=yes 7.Seal all Exposed#'artioleboard or MY 4 IAI/Health. pts y=yes D B.Use FSC Certified Materials for Interior Finish 4 RE source pts y-=-yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 RE source pts y=yes 0 10.Install Whole House Vacuum System 3 0 Q/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Re,ource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Re:ource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Re,ource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IA(dHealth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Re:ource pts y--yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Re:ource pts y--yes; 0 - 1 1 old Total Points Available:j I Available: 140 1301 57 Total Points Project Received: 01 0 0 ,91VI, 13:data/progs/greenbuild ngguidelines/ramodelers/greenp6intsfina12.12.04protected.xls REROOF TEAR-OFF POLICY ELI COMMUNITY DEVELOPMENT DEPARTMEVT-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDI�G OFFICIAL CUPERTINO 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333-build nq(c)cugertino.orq PROJECT ADDRESS �� � APN# OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE,Z P FAX CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# COMPANY NAME ()_ E-MAIL FAX STREET ADDRESS,2 OXCITY,STATE,ZI' PHONE W q [( �1 I UNDERSTAND AND AGRLE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable F rovisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call foi-tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available wi-hin one hour. There are special hours for this service: 7:30 — 10:.;Oam and 1:00— 3:30pm (Mon—Thurs); 7:30 — 10:';Oam and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspectior is required. 5. In-Progress roof inspection is required. Call for ar in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained frori the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of/4"per foot of slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pie-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-ins)ection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. Irderstan and agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_2010.doc revised 05/17/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBI;ONTRACTOR LIST JOB ADDRESS: L PERMIT# I u OWNER'S NAME: -N 1��- (U—y PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: q C' p T C CITY/ZIPCODE:-� 'Dj) J-@ *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY IN-PECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: �— r— ��- 16) 1 Q gnature Date Please check applicable subcontractors and complete i he following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CITY OF CLVERTINO REROOF CUPERTINO PERMIT APPLICATION APN#&5r-7 `,1 Date: / Building Address: < /Off) 1fqr&V4,AL �Ilj __1 Owner's Name: sot Phone #: HOA: Yes ❑ No If Yes, provide letter from HOA Contractor: Phone #: N 1� Fax#: Cupertino Business License #: Contractor License #: 0 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles �(_ Asphalt Shingles 0( Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings r ❑ Provide I.C.C.E.S. Report # )i� To be Removed ❑ Provide Mfgr. Installation Specs. Job Description:"'Oty -'A4" Residential Commercial ❑ Green Building: Please complete relevant portion c)f the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cup;rtino's Tear-Off Policy: Ell Signature Revised 02/05/09